JAMA neurology最新文献

{"title":"Balancing Faith and Doubt in Life and Death","authors":"Robert G. Holloway","doi":"10.1001/jamaneurol.2025.2050","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.2050","url":null,"abstract":"This essay describes the author’s experience with 2 patients undergoing palliative care and the need to balance both faith and doubt in life and death.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"8 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144516234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"T1-Weighted Spin Echo Sequence and Encephalitis.","authors":"Arnaud Lapostolle,Stéphane Tran Ba,Bertrand Degos","doi":"10.1001/jamaneurol.2025.1974","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1974","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"70 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postvaccinal Meningoencephalitis With Radial Perivascular Enhancement","authors":"Lina Jeantin, Delphine Leclercq, Vincent Davy","doi":"10.1001/jamaneurol.2025.1865","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1865","url":null,"abstract":"This case report describes an atypical postvaccinal encephalitis in a 60-year-old man, with radial perivascular enhancement consistent with inflammation of glial fibrillary acidic protein–rich white matter loci.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"300 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"APOE ε4 and Risk of Intracranial Hemorrhage in Patients With Atrial Fibrillation Taking Apixaban","authors":"Santiago Clocchiatti-Tuozzo, Cyprien A. Rivier, Daniela Renedo, Shufan Huo, Adam de Havenon, Maximiliano A. Hawkes, Emily Gilmore, Lee H. Schwamm, Kevin N. Sheth, Thomas M. Gill, Guido J. Falcone","doi":"10.1001/jamaneurol.2025.0182","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0182","url":null,"abstract":"ImportanceThe <jats:italic>APOE</jats:italic> ε4 variant is causally linked to cerebral amyloid angiopathy and is a risk factor for intracranial hemorrhage (ICH) among warfarin-treated patients with atrial fibrillation. Nevertheless, its impact on those treated with apixaban remains unknown.ObjectiveTo test the hypothesis that <jats:italic>APOE</jats:italic> ε4 allele carriership is associated with an increased risk of ICH in patients with atrial fibrillation taking apixaban.Design, Setting, and ParticipantsThis cohort study involved data from the All of Us Research Program, a longitudinal, population-based study in the United States. Inclusion criteria were age older than 50 years, history of atrial fibrillation, and anticoagulation with apixaban. Participants with a history of ischemic stroke or ICH were excluded. Up to 3 years of follow-up data were available. Data were collected from 2017 to 2022 and analyzed from November 2023 to December 2024.Exposure<jats:italic>APOE</jats:italic> ε2, ε3, and ε4 were ascertained using variants rs429358 and rs7412. <jats:italic>APOE</jats:italic> ε4 was modeled dichotomously (noncarriers [no alleles] vs carriers [1 or 2 alleles]).Main Outcomes and MeasuresIncident ICH, including any new intraparenchymal, subdural, or subarachnoid hemorrhage after initiation of apixaban therapy.ResultsOf 413 477 All of Us participants, 2038 were eligible. Their mean (SD) age was 71 (9) years; 918 (45%) were female, 1120 (55%) were male, and 1710 (83%) had European ancestry. Among these participants, 483 (23.7%) were carriers of at least 1 <jats:italic>APOE</jats:italic> ε4 allele. After a median follow-up of 2.9 years, 26 participants sustained an ICH (cumulative incidence, 1.5%; 95% CI, 1.0%-2.2%), of whom 12 (cumulative incidence, 3.1%; 95% CI, 1.7%-5.3%) were carriers and 14 (cumulative incidence, 1%; 95% CI, 0.6%-1.7%) were noncarriers (<jats:italic>P</jats:italic> = .007). Multivariable Cox proportional hazard models confirmed this association: compared with noncarriership, <jats:italic>APOE</jats:italic> ε4 carriership was associated with a 3-fold increase in the risk of ICH (hazard ratio, 3.07; 95% CI, 1.42-6.65). <jats:italic>APOE</jats:italic> information improved the discrimination of risk prediction scores (C statistic of 0.74 and 0.68 for models with and without <jats:italic>APOE</jats:italic>, respectively; <jats:italic>P</jats:italic> = .03).Conclusions and RelevanceFurther research is needed to evaluate whether cerebral amyloid angiopathy mediates the observed association and whether <jats:italic>APOE</jats:italic> e4 information improves clinical decision-making about anticoagulation therapy in patients with atrial fibrillation. The latter is important now that <jats:italic>APOE</jats:italic> information is used in clinical settings to guide antiamyloid treatment for Alzheimer disease and has been returned to millions of persons by direct-to-consumer genotyping companies.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"27 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meningitis as an Attack Phenotype of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease.","authors":"Albert Aboseif,Nee Na Kim,Gabriela Bou,Nabeela Nathoo,Yong Guo,Julie Pique,Anne Kerbrat,Bertrand Audoin,Sarah Demortiere,Bertrand Bourre,Jonathan Ciron,John J Chen,Laura Cacciaguerra,Michel Toledano,Amy May Lin Quek,Grace Gombolay,Romain Marignier,Yael Hacohen,Eoin P Flanagan","doi":"10.1001/jamaneurol.2025.1774","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1774","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"43 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"My Sightless Journey-A Story of Perseverance.","authors":"David M Greer","doi":"10.1001/jamaneurol.2025.1654","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1654","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"44 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal Social Determinants of Health and Risk of Perinatal Hypoxic-Ischemic Encephalopathy.","authors":"Dawn Gano,Michael W Kuzniewicz,Diana Montoya-Williams,Aaron Scheffler,Elena Fuentes-Afflick,Yvonne W Wu,Marie-Coralie Cornet","doi":"10.1001/jamaneurol.2025.1659","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1659","url":null,"abstract":"ImportancePerinatal hypoxic-ischemic encephalopathy (HIE) is an important cause of mortality and long-term morbidity. The association between maternal social determinants of health (SDOH) and perinatal HIE has not been established.ObjectiveTo examine the association of maternal race, ethnicity, and other SDOH with perinatal HIE.Design, Setting, and ParticipantsThis cross-sectional study of a birth cohort of insured maternal-neonatal dyads with births between January 1, 2012, and July 31, 2019, examined neonates born at 35 weeks' gestation or later at 15 Kaiser Permanente Northern California hospitals. Data were analyzed from May 12 to August 31, 2024.ExposuresMaternal race and ethnicity were classified by self-report. Other measures of SDOH included the neighborhood deprivation index (NDI), a marker of neighborhood-level socioeconomic disadvantage, and being publicly insured.Main Outcomes and MeasuresThe primary outcome was perinatal HIE, defined as the presence of perinatal acidosis (cord gas pH <7 or base deficit ≥10 mmol/L, or base deficit ≥10 mmol/L on first infant blood gas sample obtained before 2 hours of age), and neonatal encephalopathy, confirmed by medical record review.ResultsOf 290 535 newborns, 51.1% (148 158) were male, and the mean gestational age was 39 weeks; 25.8% (n = 75 011) were Hispanic, 24.6% (n = 71 366) were non-Hispanic Asian or Pacific Islander, 6.4% (n = 18 602) were non-Hispanic Black, 4.2% (n = 12 214) were non-Hispanic multiracial, and 37.6% (n = 109 147) were non-Hispanic White. Maternal race and ethnicity data were missing for 1.4% of newborns (n = 4195). The prevalence of perinatal HIE was higher among newborns of non-Hispanic Asian (0.2%; risk ratio [RR], 1.38 [95% CI, 1.06-1.80]), non-Hispanic Black (0.2%; RR, 1.66 [95% CI, 1.15-2.14]), and non-Hispanic White mothers (0.2%; RR, 1.54 [95% CI, 1.21-1.95]) than newborns of Hispanic mothers (0.1%). Black and Hispanic mothers were more likely to reside in neighborhoods with greater socioeconomic disadvantage and to be publicly insured. After adjustment for NDI, public insurance, and clinical characteristics, neonates of Hispanic mothers had 25% lower odds of HIE compared with neonates of non-Hispanic White mothers (odds ratio, 0.75 [95% CI, 0.60-0.95]; P = .02). The highest tertile of NDI, indicating higher neighborhood deprivation, was independently associated with decreased odds of HIE compared with the middle tertile (odds ratio, 0.78 [95% CI, 0.62-0.98]; P = .03).Conclusions and RelevanceThese findings suggest that there was a lower prevalence of perinatal HIE among newborns of Hispanic mothers and among newborns of mothers who resided in the most socioeconomically disadvantaged neighborhoods. Determining the root causes for the lower risk of perinatal HIE among specific subgroups may inform the development of targeted HIE prevention policies.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"228 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Dystonia Phenotype in Wilson Disease.","authors":"Yulong Yang, Xiang Li, Wenming Yang","doi":"10.1001/jamaneurol.2025.1639","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1639","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Differences in Dementia Incidence Among US Veterans","authors":"Christina S. Dintica, Amber L. Bahorik, Feng Xia, John Boscardin, Kristine Yaffe","doi":"10.1001/jamaneurol.2025.1536","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1536","url":null,"abstract":"ImportancePrior studies of dementia incidence in the US often focused on narrow regions, leaving regional variation unclear and potential explanatory factors unknown.ObjectiveTo investigate geographic differences in dementia incidence across the US among older adults enrolled in the Veterans Health Administration (VHA) system.Design, Setting, and PopulationCohort study spanning October 1999 to September 2021 with a mean follow-up time of 12.6 years. Data were analyzed from October 2023 to September 2024 among a random sample of 1 268 599 dementia-free veterans aged 65 years or older with available zip code information in locations across the US. We excluded 22 512 with missing zip codes, 265 850 with no follow-up, and 37 370 with prevalent dementia.ExposureGeographical region categories across the US were defined using the Centers for Disease Control and Prevention (CDC) National Center for Chronic Disease Prevention and Health Promotion definition, which divides the US into 10 regions, each composed of 4 to 7 states.Main Outcomes and MeasuresDementia diagnoses were based on <jats:italic>International Classification of Diseases</jats:italic> codes and calculated for zip codes within the CDC regions. Poisson regression models were used to calculate dementia incidence per 1000 person-years and assess regional differences in incidence rate ratios with several covariate models.ResultsAmong the 1 268 599 participants (mean age, 73.9 [SD, 6.1] years; n = 25 335 [2%] female), dementia incidence rates per 1000 person-years were lowest in the Mid-Atlantic (11.2; 95% CI, 11.1-11.4) and highest in the Southeast (14.0; 95% CI, 13.8-14.2). Compared with the Mid-Atlantic, the regions with the greatest demographically adjusted incidence included the Southeast (rate ratio [RR], 1.25; 95% CI, 1.22-1.28), Northwest (RR, 1.23; 95% CI, 1.20-1.27), Rocky Mountains (RR, 1.23; 95% CI, 1.20-1.26), South (RR, 1.18; 95% CI, 1.15-1.20), Midwest (RR, 1.12; 95% CI, 1.09-1.14), and South Atlantic (RR, 1.12; 95% CI, 1.10-1.14); the remaining regions had similar (&amp;amp;lt;10% difference) incidence. Additional adjustments for rurality and cardiovascular comorbidities and accounting for the competing risk of death produced similar results.Conclusions and RelevanceAmong older adults in the VHA, dementia incidence varied significantly across US regions, independent of key covariates. These findings highlight the need for targeted health care planning, public health interventions, and policy development.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"80 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144238296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Copathology in Atypical Parkinsonism-The Rule Rather Than the Exception?","authors":"Ivan Martinez-Valbuena, M Carmela Tartaglia, Gabor G Kovacs, Anthony E Lang","doi":"10.1001/jamaneurol.2025.1630","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1630","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}